Provider Demographics
NPI:1679212732
Name:DIAZ FRED, SHERLEY MARIE (MS)
Entity Type:Individual
Prefix:
First Name:SHERLEY
Middle Name:MARIE
Last Name:DIAZ FRED
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9677
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9677
Mailing Address - Country:US
Mailing Address - Phone:787-564-1168
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE JOSE C BARBOSA
Practice Address - Street 2:ESQ LUNA
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-564-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6480103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool